Healthcare Provider Details

I. General information

NPI: 1972921674
Provider Name (Legal Business Name): GEOVANNI J CAMACHO-GALVAN R.T (R)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6175 E OWENS AVE
LAS VEGAS NV
89110-1859
US

IV. Provider business mailing address

6175 E OWENS AVE
LAS VEGAS NV
89110-1859
US

V. Phone/Fax

Practice location:
  • Phone: 702-306-0325
  • Fax:
Mailing address:
  • Phone: 702-306-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number462333
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: